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OPTO3003 > DDX > Flashcards

DDX Flashcards

1
Q

LOFTSEA In assessing PC

A

Location: R/L eye, which VF
Onset: Time frame
Frequency: how often
Type: how bad are symptoms, type of pain
Self-treatment: What helps symptoms
Effect: how does this affect lifestyle
Associated signs and symptoms: relationship to alternate disease

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2
Q

Components of case history

A

PC: presenting complaint
POH: ocular history
FOH: family ocular history
FMH: family medical history
GH: general health + medication
VT: Visual tasks (hobbies/driving)

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3
Q

Screening questions in PC:

A

How is D/I/N vision
Age/effect of correction
Sore/red/itchy eyes
Flashing lights/floaters
Headaches
Double vision

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3
Q

PC refractive error:

A

Binocular blur
Squinting
Headaches
Esotropia > diplopia
Far/near working distance

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4
Q

Hyperopia PC:

A

Asymptomatic (latent)
Blur near>dist
Strabismus > amblyopia
Asthenopia / headaches
Loss of concentration

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4
Q

Astigmatism PC:

A

Blur at all dist
Asthenopia / headaches
Squinting
Poor focus
Light haloes

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5
Q

Presbyopia PC:

A

Blur at near
Asthenopia / headaches
Fatigue
Increased working distance and light level

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6
Q

Ocular disease in cataracts:

A

Inflammation (uveitis) > PSC
Corticosteroid use > cataracts
Vitrectomy > ascorbate loss > oxidative stress

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7
Q

Nuclear cataracts:

A

Most common
Accumulation of high weight aggregates > hardening (sclerosis)/^RI > scattering > VA/contrast loss/myopic shift
^fluorescent chromophores > nuclear brunescence > blue-yellow color defect (Tritan)

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8
Q

Cortical cataracts:

A

Hydration of cortex > subcapsular vacuoles > ray like transparent liquid spaces > decrease in soluble proteins/^insoluble proteins > opacification of rays > cuneiform opacities originating from periphery
Localized RI change > astigmatism
Glare in night (greatest glare)

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9
Q

PSC:

A

Age/Stress/UV/H2O2/cytokines > dysplastic epithelia migrate to pos. pole > collate with adjacent fibers > balloon cell formation > dysfunctional Na/K ATPase > swelling > intercellular/interfiber vacuoles and extracellular granular material formation > disruption of regular lens organization > light scatter
Vacuoles in flux
Near/light VA worse than far/dark (miosis)

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9
Q

Slit lamp examination of DED:

A

Lid hyperemia
Tear film debris
Conj. Hyperemia
SPEE (superficial punctate epithelial erosions)
Meibomian capping (MGD/bleph.)
Tear meniscus (reduced in ADDE)

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10
Q

DED symptoms:

A

Pain/burn/grit/FBF
Watering (CN6 activation)
Hyperemia
Lid fatigue
Intermittent blur (better on blink)
Struggle on screen use (blink rate 11/m > 4/m)
Photophobia

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11
Q

Blepharitis:

A

Lid inflammation from Staphyloccal or dermatitis
Ant. Affects zeis glands/lash follicles (crusty scales) > bleph debris decreases tear quality
Pos. affects meibomian glands (meibum capping) > EDE + inflammatory mediator passage from lid

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11
Q

DDX dry eye:

A

Allergic conjuntivitis: itchy
Blepharitis: lid crusting
Pharmacological: medical history
Neurotrophic keratopathy: corneal sensitivity test
Pterygium/pingueculum
CLARE

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12
Q

BCC symptoms:

A

Superficial: well defined red patch. Slow growth, w/crusting and irritation
Nodular: Pearly/translucent/skin c./pink papule/nodule. Growth > rolled edge w/central depression > ulceration w/bv
Morphoeic/sclerosing: white/waxy patch from longstanding presence
Locally invasive, rarely metastatic

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13
Q

SCC presentation:

A

Erythematous, tender papule/nodule. Commonly presents as ulcer with hyperkeratosis/horn.
Lesion expansion > recurrent ulceration/bleeding

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13
Q

Pterygium symptoms:

A

Wing fibrovascular growth at 3/9o’clock, from limbus over cornea. Can form iron deposition at boarder (Stockers line)
WTR astigmatism when on visual axis, can flare up

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14
Q

Signs of conj. Naevi developing into malignant melanoma:

A

Development post 20y
Sudden onset / rapid growth / pigment change
Abnormal location (fornices/palpebral conj.)
Increased thickness w/feeder BVs

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14
Q

Signs of choroidal naevus forming malignancy:

A

Growth
Blur, metamorphospia, VF loss, photopsia
>5mm diameter, >1mm deep
Presence of orange lipofuscin
Near OD
Associated serous RD

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15
Q

Differentiation between naevus and melanoma:

A

Asymmetry
Boarders (irregular/poor definition)
Color (variable pigmentation)
Diameter (>6mm)
Evolution

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16
Q

OSSN symptoms:

A

Leukoplakic: localized thickening of stratifies squamous epith. W/ white keratosis plaque
Papillomatous: vascularized mass, w/ BV corkscrews to supply metabolic proliferating cells
Gelatinous: poorly defined, transparent thickening of squamous epith.
All stain with NaFl due to irregular tight junctions of abnormal squamous cells

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17
Q

Signs of choroidal melanoma:

A

Elevated nodular mass under RPE
60% near OD/fovea
Clumps of orange pigment lipofuscin
RPE atrophy/drusen/exudative RD

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18
Q

Causes of anisocoria:

A

Horners
Physiological (EW asymmetric inhibition)
CN3 palsy
Adies tonic
Aberrant regen (CN3p / adies)
Pharmacological
Pupil damage (trauma/Sx)
AAGC

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19
Q

Horners syndrome symptoms:

A

Disruption of sympathetic innervation to pupil dilator / mullers / ciliary body / facial sweat glands.
Causes Miosis / partial ptosis (1mm) / anhidrosis (not 3rd order) / accommodative excess / Conj. BV dilation
Congenital cases > Lighter/Darker Brown/Blue eyes

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19
Q

Common causes of horners syndrome:

A

1st : brainstem/spinal disease (vascular/tumor), diabetic neuropathy
2nd: Pancoast tumor, carotid/aortic aneurysm, neck lesion
3rd: carotid aneurysm, cavernous sinus mass, cluster headaches

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20
Q

CN3 palsy symptoms:

A

Mydriasis: Pia BV compression > pupillomotor fiber ischemia
Full ptosis: sup. Levator innervation loss
Down/out turn: Sup/Inf/medial rectus, inf. Oblique innervation loss
Thunderclap headaches

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21
Q

Causes of CN3 palsy:

A

Causes of CN3 palsy:
Pupil involving: compressive lesion/aneurysm on pia BV for parasym. fibers
Pupil sparing: DM/HT > main trunk ischemia
Giant cell arteritis (temple pain) / Pos. communicating artery aneurysm / cavernous fistula common

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22
Q

Adies pupil symptoms:

A

Poor near focus in one eye
Slow constriction at neat from aberrant regen. (light-near dissociation)
Dilated pupil with poor direct and consensual response
>2months > slow constriction at near response (Light-Near dissociation)

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22
Q

DDX for red eye:

A

CL related
Corneal epithelial defect
Ant. Chamber disease
Eye wall inflammation
Sub conj. Haemorrhage

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23
Q

Common pharmacologic mydriasis/miosis:

A

Tropicamide: Muscarinic antagonists > Ach receptor block > sphincter paralysis
Phenylephrine: adrenergic 1 agonist
Pilocarpine: muscarinic agonist > Ach receptor upregulation > miosis
Apraclondine: Alpha agonist > dilation (weak a1, strong a2)
Tamulosin: Alpha antagonist > adrenaline receptor block > dilator paralysis

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24
Q

AACG presentation:

A

Hx DM/HT
Ache pain w/ Headache, nausea, vomiting
IOP(40-60), closed AC angle, corneal oedema
Mid dilated pupils
Blur based on symptom severity
Ache, nausea

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24
Q

Types of ptosis:

A

Myogenic (MG, simple congenital, blepharophimosis)
Neurogenic (CN3, horner, marcus gunn)
Mechanical
Aponeurotic (LPS disinsertion)
Pseudooptosis

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24
Q

Pseudoptosis:

A

Dermatochalasis
CN7 palsy (brow)

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25
Q

CL related red eye DDX:

A

CLARE
CLPU
GPC
Tight lens syndrome
Dry eye

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26
Q

Corneal defect red eye DDX:

A

Keratitis
Abrasion from trauma
Recurrent corneal abrasion
Forign body

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27
Q

Anterior chamber disease red eye DDX:

A

Uveitis
AACG

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28
Q

Eye wall inflammation red eye DDX:

A

Scleritis
Episcleritis
Conjuntivitis (infection/inflammatory)

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28
Q

Presentation of episcleritis:

A

Hx RA / autoimmune cond
Irritated to ache pain
Diffuse or sectoral hyperemia
W/o blur/watering/corneal involvement
Phenylephrine 2.5% blanches episcleral/conj. Vessels

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28
Q

Presentation of corneal abrasion (trauma):

A

Hx trauma
Sharp pain
Watery, photophobic, blur
*W/o infiltrates, rare AC inflammation

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29
Q

Presentation of corneal erosion

A

Hx trauma/recurrance (<>3mo)
Associated poor healing/DED/dystrophy
Severe sharp pain
Watery, photophobic, blur
*W/o infiltrates, rare AC inflammation

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29
Q

Types of infectious conjuntivitis:

A

Bacterial (hyper-/acute/chronic)
Adenoviral (follicular/PCF/EKC)
HSV
Chlamydial (adult inclusion/trachoma)
Fungal / parasitic / protozoan
Neonatorum

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30
Q

Presentation of uveitis:

A

Hx uveitis episodes/autoimmune cond.
Ache pain
Circumlimbal hyperaemia, photophobia, corneal oedema/precipitates (endoth.)
AC inflammation, decreased IOP
Rare pos. synechiae, hypopyon(white BC inf. AC), mitotic pupil (spasm)
Blur based on symptom severity

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31
Q

Types of non-infectious conjunctivitis:

A

Toxic follicular
Molluscum contagiosum
Stevens-johnson syndrome
Graft vs. host disease
Ocular cicatrical pemphigoid
Sup. Limbic kerato-

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31
Q

Presentation of sub conj. Haemorrhage:

A

Hx trauma/cough/vomit/blood thinners
(warfarin)
Light or no pain
No symptoms (rare conj. Oedema)

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32
Q

Presentation of scleritis:

A

Hx RA / autoimmune / GCA
Deep boring/ache pain
Scleral hyperemia (blue colouring)
W/o blur/watering/corneal involvement
Phenylephrine 2.5% will not blanch scleral vessels

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33
Q

Types of allergic conjunctivitis:

A

SAC/PAC
Atopic
Vernal
GPC

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34
Q

Actue bacterial conjuntivitis causes/symptoms:

A

Gram+: Staph/strep aureus/pneumoniae
Gram-: haemophilus
Unilateral > bilateral (2d)
Burning pain w/mucopurulent discharge (matting) and diffuse hyperaemia
Rare papillae on tarsal conj.

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34
Q

Follicular adenoviral conjuntivitis:

A

Serotyes 1-11/19
Unilateral > bilateral (1w)
Ocular discomfort, watery, hyperaemia, tarsal follicles, preauricular lymphadenopathy
Self limiting 1-3w

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34
Q

Pharyngeal conjuntival fever:

A

Adenovirus serotype 3/4/7
Pharyngitis, fever, conjuntivitis
Mild hyperemia, chemosis, watery, follicles
Common SPEE, swolen preauricular lymphnodes (ears)
Self limiting 2-3w, cold compress w/lubricants (comfort)

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35
Q

Herpes simplex conjuntivitis

A

Common HSV-1 (ocular) initial infection (<5yo).
Irritation, Watery, follicles, preauricular lymphadenopathy, HSV vessicles (lids),
Dendritic ulcer
Self-limiting 1-2w
Corneal involvement > acyclovir 3% 5/d 1w
No steroids

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35
Q

Hyperacute bacterial conjuntivitis causes/symptoms:

A

Neisseria gonorrhoeae via genital spread
Pain + tender preauricular lymphadenopathy
Rapid onset uni/bilateral, hyperaemia/chemosis w/great purulent discharge

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36
Q

Chronic bacterial conjuntivitis causes/symptoms:

A

Any bacterial conjuntivitis lasting > 3w
Related to blepharitis
Burning pain
Light hyperaemia on bulbar and tarsal conj.
Mucoid discharge w/papillae, lid crusting

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37
Q

Molluscum contagiosum conjuntivitis:

A

Poxvirus nodules containing intracytoplasmic inclusions toxic to conj.
Common 2-4yo
Lid umbilated nodules
Conj. Hyperemia, follicles, mucoid
Self limiting 3-12m, lid nodule excision if needed

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37
Q

Trachoma cause/symptoms:

A

C.trachomatis bacteria serotype A/B/C
Initial infection (1w incubation) > mild mucopurulent conjuntivitis
Recurrent infection > active chronic inflammation
Late stage > inactive inflammation

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37
Q

Epidemic keratoconjuntivitis causes/symptoms:

A

Adenovirus serotype 8/19/37
Follicles, hyperemia, chemosis, watery, swolen preauricular lymph
Common subconj. Haemorrhage / membranes (true/pseudo)
SPEE > subepithelial infiltrates
Symblepharon / scarring on healing

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38
Q

Trachoma active inflammation:

A

Irritation, blur
Follicular/Papilliary hypertrophy
Superior pannus, limbus swelling/follicles
Epithelial keratitis
Mucopurulent discharge

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38
Q

Acute inclusion conjuntivitis:

A

Chlamydia trachomatis bacteria serotye D-K (1-2w incubation)
Unilateral hyperemia, watery, purulent
Large follicles w/papillary hypertrophy (tarsal conj.) > pannus
Swolen preauricular lymph
Rare SPEE/stromal infiltrate/limbal swelling
* GP systemic azithromysin 1g.

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39
Q

Toxic follicular conjuntivitis:

A

Long term toxin exposure.
Mascara/timolol/gentamicin/preservatives > type IV delayed hypersensitivity
Uni/Bilateral hyperemia
Mixed follicles/papillae on tarsal conj.
Cold compress and removal of offending agent

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39
Q

VKC symptoms:

A

Bilateral recurrent, common men <20y w/eczema/asthma
Burning, ropy mucoid, irritation
severe itching
Papillary hypertrophy w/mucous deposits between giant papillae > keratopathy
Limbal gelatinous papillae w/apical white spots (tarantas dots)
Corneal pannus, punctate, vernal shield ulcer
Keratoconus from rubbing

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39
Q

Trachoma inactive inflammation:

A

Cicatrical fibrosis of conj. > entropion > corneal scarring
Fibrosis/fusion of conj. > symblepharon
Tarsal scarring > white lines (arlt’s line)
DED from meibomian/goblet loss

39
Q

AKC symptoms:

A

Rare bilateral, associated atopic deratitis, common late teenage years
Similar to VKC but more severe
Severe itching, mucoid, hyperemia, chemosis
Red macerated lids, blepharitis, narrow fissure
Papules > giant papules
Conj. cicatration > symblepharon
SPEE/erosions/keratokonu

40
Q

SAC/PAC symptoms:

A

Recurrent mild bilateral hyperemia, tearing, mucoid
Lid oedema, conj. Chemosis, tarsal papules
Itching, associated respiratory symptoms

40
Q

Superior limbic keratoconjuntivitis SLK:

A

Common from blink dysfunction from hyperthyroidism
Ocular discomfort, mucoid, DED
Sup. Hyperemia, papillary hypertrophy, SPEE
Requires treatment of underlying cause

41
Q

Signs/symptoms of bacterial keratitis:

A

Pain: severe / increasing
Epithelial defect: boggy edges (stromal oedema)
Discharge: mucopurulent
Ant. Chamber response: hypopyon/ low IOP
Location: central, away from limbal vessels
Size: larger than 2mm
Conj. Hyperemia

41
Q

Acanthamoeba keratitis risks:

A

Present in water sources
Poor CL use > biofilm build up
Secondary to damage/HSV

42
Q

Acanthamoeba keratitis early signs:

A

Inconsistent symptoms following incubation
FBS > blur > photophobia
Pain: significant / disproportionate (radial keratoneuritis)
Epiphora / blepharospasm: CNV activation
Non-specific epitheliopathy: hazy/pseudo dendrites

42
Q

Risk factors for keratitis:

A

CLs
Sx/trauma
DED/bleph/neutrophic keratitis
Co-infection (acanthamoeba/HSV)
Blink dysfunction
Immunosuppression
Immune loss (DM/malnutrition)

42
Q

CL risk of keratitis:

A

Low to Dk/t value (soft CLs)
Least with RGP lenses
From hypoxia reducing epithelial adhesion > CLARE/CLPU
Usually gram- psuedomonas aeruginosa
Smoking, poor hygiene, blepharitis

43
Q

DDX keratitis:

A

CL related: CLARE/CLPU
Corneal defect: abrasion/recurrent erosion
Infective: acan./herpectic/fungal/marginal/bacterial

44
Q

Symptoms of CL edema (hypoxia):

A

Acute:
Pain, blur, photophobia, tearing
Diffuse epithelial superficial keratopathy
Chronic (neovasc.):
No pain, light blur, endoth. Blebs.
Corneal neovasc:
Vessel presence

44
Q

Fungal keratitis risks:

A

Trauma (esp vegetables)
Biogel formation
Tropical climate
Immunosupression
Hydrogel CLs

44
Q

Acanthamoeba keratitis late signs:

A

Weeks after incubation; in addition to early signs
Stromal involvement: nummular infiltrates (snow storm)
Pain: extreme (pathogen around stromal nerves)
Progression:
Large epithelial defect/stromal thinning
Anterior uveitis (hypopyon)
Inflammatory AACG

44
Q

Fungal keratitis symptoms:

A

Pain: Slow progression (weeks) w/nerve damage (lesser pain)
Discharge: common from bacterial co-infection
Infiltrates: feather/button
Conj. hyperemia

45
Q

Symptoms to differentiate fungal keratitis:

A

Filamentous: feathery infiltrates > ant. Chamber reation (hypopyon)
Yeast: Button infiltrate > epith. Ulcer

45
Q

Symptoms of HSK:

A

FBS, photophobia, epiphoria, blur, hyperemia
desensitisation
Dendritic lesion
IOP increase (trabeculitis)
Lid HSV vessicles

46
Q

HSK corneal lesion:

A

Small opaque epith. Cells > desquamation of central cells > punctate erosions progress/branch
Terminal bulbs contain swolen virus laden cells.
NaFL stains central desquamation
Lissamine stains damaged bulbs

47
Q

CL complications:

A

Corneal hypoxia
Corneal neovasc.
CL-associated dry eye
3-9’ staining
Sup. Epith. Arcuate lesion (SEAL)
Tight lens syndrome
Toxic/allergic kera/conjuntivitis
CLARE
Culture neg. Peripheral ulcer (CLPU)
Microbial keratitis

48
Q

GPC signs/symptoms:

A

Ocular irritation, itching, hyperemia
^mucus deposition on CL > ^deposit > CL intolerance
Irritation worsens on CL removal (papillae contact ocular surface)
Micro/macropapillae on sup./inf. Tarsal conj. w/mucus deposit/discharge
Mucus/cellular deposit on CL > blur

48
Q

CLARE symptoms:

A

Severe pain, photophobia, tearing
Intense hyperemia
Focal/diffuse subepithelial infiltrates across cornea
Intact epithelium, with light superficial punctate keratopathy
No mucopurulent discharge (sterile inflammation)

48
Q

CL associated dry eye symptoms:

A

FBS, gritty, tearing, burning
Ocular surface staining, hyperemia, deposits on CL
Symptoms worsen towards end of day

49
Q

3/9’ staining symptoms:

A

CL intolerance/awearness
FBS/gritty
Mild punctate epithelial loss > NaFl staining peripheral cornea at 3/9’
w/o localised conj. Hyperemia

49
Q

Tight lens symptoms:

A

FBS, gritty, tearing, burning
Limbal hyperemia/staining
Severe cases > infiltrates > AC reaction
Symptoms worsen towards end of day

49
Q

CNPU/CLPU symptoms:

A

Irritation, photophobia, tearing
Peripheral well-defined circular epithelial lesions/ulcers w/stromal infiltrates
Hyperemia, AC reaction (severe)
Commonly with pos. Blepharitis (S.aureus)
Infiltrates larger than epith. Defect (sterile inflammation)

50
Q

Causes of HSV reactivation:

A

UV (induced immunosuppression)
Trauma
CLs
Stress

50
Q

Symptoms of initial HSV infection:

A

Primary manifestation of blepharokeratoconjuntivitis
Lid vessicles, follicular conjuntivitis, corneal microdendrites

50
Q

CL related toxic/allergic conjuntivitis symptoms:

A

Lens insertion > acute pain
Conj. Hyperemia / chemosis > take 48h to resolve
Diffuse epithelial punctate staining w/ small intraepithelial infiltrates

50
Q

VZV initial infection:

A

Chickenpox
Rash, fever, malaise, pneumonia
Traves to dorsal root/CN sensory ganglia (retrograde)
Lies dormant

51
Q

DDX between CPLU and MK:

A

Pain: severe/increasing
Epithelial defect: soggy (stromal oedema) / pseudodendrites (acan.)
Discharge: mucopurulent (bacterial > conjuntivitis)
Ant. Chamber reaction: sterile infiltrates of intraocular infection
Location: central ulcer (bacteria avoiding limbal vessels w/leukocytes)
Size: ^2mm infectious
[Pedals]

51
Q

VZV reactivation:

A

Loss of cell mediated immunity against virus (stress/age) > Shingles
Causes prodromal malaise (3d) > fever, fatigue, painful rash
HZO when virus travels opthalmic branch of CNV

52
Q

Clinical presentation of HZO:

A

Lid vessicles/edema/inflammation
Conjuntivitis w/ papillae/follicles/membranes
Epi/scleritis
Keratitis
Epitheliopathy (pseudo-dend.)
Uveitis
Optic neuritis
Post-herpetic neuralgia
Hutchinson’s sign (nose rash)

53
Q

Symptoms of HSK dendritic ulcer:

A

Light pain (neurotrophic), FBS, tearing
Photophobia, blur, hyperemia
Hx prior attacks
Significant pain > healing defect/acan.

54
Q

Signs of dendritic ulcer:

A

Opaque punctate epith. > branching lesion w/terminal bulb
NaFl pools in central desquamation / lissamine stains bulbs
Underlying stroma opaque
Corneal desensitisation
^IOP < trabeculitis
Viral vessicles on lids
Steroids/immunocomp. > satelite lesions/bacterial co-infection

55
Q

Neurotrophic keratitis presentation:

A

Light pain, photophobia, blur
Corneal desensitisation
Irregular epith. Punctate erosions > ulceration > scarring/neovasc.
Smooth boarders

55
Q

Presentation of geographic/metaherpectic ulcer:

A

G: enlarged epithelial ulcer, uneven boarders (unlike neurotrophic), NaFl stains centre
M: poor healing of G, NaFl stains outer
Lissamine green has reverse staining

56
Q

Necrotising stromal HSK symptoms:

A

Photophobia, tearing, blur, discomfort
Dense stromal infiltrates, stromal oedema, necrosis, melting (viral replication in keratocytes)
Leads to corneal thinning, AC reaction (^IOP / hypopyon)

56
Q

Immune Stromal HSK symptoms:

A

Photophobia, tearing, blur, discomfort
Nummular infiltrates under prior epith. Keratitis
Disciform keratitis presents as diffuse/focal/ring-like
Significant inflammation > stromal vascularisation
Microdendrites indicate active corneal disease to be managed first
Resolves with thinning, opacification, ghost vessels

56
Q

HZO manifestations:

A

Photophobia, blur, tearing
Light pain
50% HZO cases > Punctate epithelial keratitis > swollen lesions with live virus >
Pseudo-dendrites: branching swollen virus laden epith.
w/wo stromal infiltrates

57
Q

MG symptoms:

A

Limb weakness
Poor facial expression
Poor swalling/speaking/breathing
LPS loss > ptosis
EOM loss > diplopia
Symptoms worsen with use (sustained upgaze)

57
Q

HZO disciform stromal keratitis symptoms:

A

5% HZO cases after 4w from onset
Localised inflammation full depth of stroma > immune ring
Corneal oedema w/anterior uveitis
Limbal vascular keratitis > corneal neovasc.
Chronic/recurrent cases > scarring

57
Q

Endothelial HSK symptoms:

A

Significant photophobia, blur, light pain (light ulceration)
Light haloes, tearing
Stromal oedema, endo. Precipitates, AC flare
Stromal Wessely ring > scar > blur for years
Disciform endothelitis as circular inflammation
Trabeculitis > ^IOP

57
Q

HZ nummular stromal keratitis symptoms:

A

25% HZO cases
Fine granular subepithelial infiltrates under punctate epithelial keratitis
Vision effect depends on location

57
Q

Etiology factors for autoimmune diseases:

A

Genetic predisposition
Environmental triggers
Loss of self-tolerance
T-cell activation/differentiation
Autoantibodies
Activation of autoimmune response

58
Q

HZO keratouveitis symptoms:

A

Blur, pain (ciliary spasm), photophobia, conj. Hyperemia
AC flare, iris synechiae, cornea oedema
Trabeculitis / meshwork blocked by WBC> ^IOP
Chronic/recurrent > corneal oedema / Iris atrophy

58
Q

Common autoimmune diseases affecting the eye:

A

TED / Graves
Sjrogrens
Myasthenia gravis
MS
GCA
T1 DM
RA
Systemic lupus erethematosus

58
Q

Sjogrens syndrome systemic symtoms:

A

Dry mouth > poor speaking > dental cavities
Fatigue > joint pain > peripheral neuropathy
Associated RA / SLE
AADE

59
Q

MS ocular symptoms:

A

Optic neuritis: VF loss/pain
Diplopia: EOM loss
Nystagmus: eye coordination loss
Internuclear ophthalmoplegia: medial longitudinal fasciculus loss (MR loss)
Uveitis: inflammation secondary to macula oedema

60
Q

Optic neuritis (from MS):

A

ON inflammation > sudden painless loss of vision (days)
Loss of contrast, red desaturation, RAPD
+- Pain on eye motion, ON oedema
50% MS Px experience

61
Q

GCA symptoms:

A

Persistent headache near temples w/scalp tenderness
Jaw pain on chew/talk
Fatigue/malaise/weight loss/ night sweats
Ophthalmic artery affected > Arteritic ischemic optic neuropathy (AAION) > painless sudden vision loss, RAPD

61
Q

Diabetes related ocular diseases:

A

DR: endo. Loss of small BV
Cataract: lens protein glycation
DED: nerve damage > poor tear reflex/neurotrophic GF
CN palsy: secondary D.neuropathy
CR(A/V)O/BR(AV)O or NAION: endo loss

62
Q

AAION (GCA):

A

Sudden painless loss of vision
RAPD
VF loss
Pale swollen ON

62
Q

T1DM clinical presentation:

A

Polyuria: ^unregulated glucose > ^urine filtration > osmotic diuresis (^urination)
Polydipsia: osmotic diuresis > dehydration > ^thirst
Polyphagia: cells unable to intake glucose > cellular starvation > ^hunger
Weight loss: poor cellular glucose metabolism > fat/protein breakdown for energy
Fatigue: poor metabolism > low energy
Blur: ^glucose > osmotic changes in lens > refraction change

63
Q

T1DM vascular complications:

A

^ glucose > BV endothelial damage
Macrovascular: coronary artery/cerebrovascular disease
Microvascular: (endo. Is sole component)
D retinopathy, D neuropathy, D nerphropathy

63
Q

Graves’ disease symptoms

A

^metabolism > weight loss, sweating, heat intolerance
Hyperactive sympathetic NS > nervousness, irritability, heart palpatiations
Negative feedback mechanism > high TH, low thyrotropin-releasing hormone
Fatigue, enlarged thyroid gland (neck), alopecia

64
Q

Thyroid eye disease risks:

A

Thyroid ophthalmopathy from 25-50% grave’s Px.
^with smoking, immunotherapy, radioactive iodine therapy (graves’ treatment)

64
Q

TED symptoms:

A

Proptosis > DED
EOM loss > muscle fibroblast fibrosis
Sup/Inf lid retraction
Soft tissue involvement > sup. Limbic keratoconjuntivitis (mechanical friction)
Compressive optic neuropathy

65
Q

Superior and inferior lid retraction in TED:

A

Inflammation > fibrosis > lid retraction > clinical signs:
Dalrymple sign: retraction in primary gaze
Kocher sign: staring/attentive fixation
Von Graefe sign: abnormal descent of upper lid on downgaze

65
Q

Proptosis DDX:

A

Infection: orbital cellulitis
Inflammatory: TED
Vasculitis: Wegener granulomatosis
Neoplasic: Lymphoma/leukemia
Orbital vascular disease: arteriovenous malformation
Trauma: orbit fracture
Pseudoptosis: Contralateral blepharoptosis

66
Q

ERM signs and symptoms:

A

irregular light reflex on red-free photography
retinal striae > wrinkles > distorted BV
Macular pseudo holes, cystoid macula oedema, haemorrhages
Metamorphopsia

66
Q

Soft tissue involvement in TED:

A

Superior limbic keratoconjuntivitis: secondary to mech. Friction on blink from proptosis
Soft tissue expansion > periorbital swelling
DED from lid retraction/lagopthalmos secondary to proptosis

66
Q

ERM progression

A

ERM contraction > retinal structure disruption > macula/vasculature distortion >
photoreceptor dislocation, local elevation, haemorrhages, retinal oedema

66
Q

ERM description and presentation:

A

Fibrocellular, avascular proliferation of glial cells forming translucent sheet.
Presents decreased VA ~6/12

67
Q

Macula hole Stage 1:

A

1a (impending): muller cone detaches from photoreceptor layer forming cystic cavity
Inner/outer retinal layers still intact
1b (occult): loss of foveal depression, displacement of outer retinal layers.
50% stage 1 holes resolve spontaneously

68
Q

Macula hole description:

A

Full thickness loss of retina at central macula
Idiopathic occur in females 2:1, 65y, 10% bilateral

68
Q

Macula hole stage 2:

A

Small full thickness hole
Desinence forms in ceiling of cystic cavity, pulled by vitreofoveolar attachment.
seperates partially or fully.
Almost always continues to stage 3

69
Q

Macula hole stage 3:

A

Full sized macula hole
Vitreofoveolar traction Continues desinence into photoreceptor layer
Roof detachment forms pseudo-operculum
Pos. Hyaloid face may separate from retina (partial PVD)

69
Q

Signs of macula hole:

A

1a: flat foveal depression
1b: yellow macula ring
2: retinal defect <400um, circle/oval/crescent shape
3: retinal defect >400um, red base with yellow/white dots surround by grey subretinal fluid and pseudo-operculum. May have noted pigmented demarcation line at edge of subretinal fluid cuff

69
Q

Symptoms of macula hole:

A

1: asymptomatic, slight metamorphopsia
2: decreased VA (6/15-6/120)
3: decreased VA (6/60-6/240)
Eccentric fixation can resolve better VA

69
Q

Macula hole stage 4:

A

Full sized hole with complete PVD
Usually with noted Weiss ring, circle of condensed vitreous that was attached around ON

70
Q

Lamellar macula hole signs/symptoms:

A

Asymptomatic (6/9)
Circular defect at inner retinal layer without thickening/cystic formation
Often with pseudo-operculum
Fluroescein angiography shows no abnormality

70
Q

CSR risks:

A

Stress
Corticosteroids
Males 20-50yo
Type A personality (competitive)

71
Q

Other maculopathies:

A

Diabetic
Macula oedema
AMD
Solar retinopathy
Adult citelliform dystrophy / adult BESTs disease
BESTs disease / Stargardts

71
Q

CSR symptoms:

A

Decreased VA 6/15, may improve with hyperopic refraction
Metamorphopsia / central scotoma

72
Q

CSR signs:

A

Amsler distortion
OCT dome
FFA shows sites to fluid pooling
Chronic (SRD) will be more shallow

73
Q

Hypertensive choroidopathy signs:

A

Elshnig spots: well-demarcated yellow/white areas of RPE atrophy, later develops central pigmentation
Sigrist streaks: hyperpigmented streaks overlying choroidal arteries
Pale patches under retina (RPE necrosis)
Exudates in sub-retinal space
Hypoperfusion on autofluroescence

73
Q

Ocular conditions secondary to hypertension:

A

CRAO / BRAO
CRVO / BRVO
Non-arteritic anterior ischemic optic neuropathy (NAION)
Stroke
Diabetic retinopathy

74
Q

CRAO/BRAO presentation:

A

Sudden painless loss of vision, narrow/attenuated arteries
Whitening of retina within hours (ion transport loss in ganglion axons > axonal oedema)
Cherry red spot (lack of NFL w/pigmented compounds at fovea)
Vision loss at fovea related to axonal ischemia preventing signals leaving eye
Severe > RAPD

75
Q

Early AMD clinical presentation/signs:

A

Sub-RPE basal linear deposits
Large soft drusen
Hyper/hypopigmentation
RPE/retina atrophy (w/drusen)
Geographic atrophy > visible choroid (wo/drusen)
PED from poor fluid transport (bruchs dysfunction) filled with serous fluid/haemorrhage/drusen
Drusen coalescence > drusenoid RPE detachment

75
Q

Causes and risk factors of AMD:

A

Age: loss of antioxidant mechanisms
UV(long wavelength): ^free radicals > phototoxicity > cell damage
Genetic: ABCR gene on chromosome 1q32 for complement factor H (protective factor)
Smoking: double risk (free radicals)
^BMI, HT (^BMI), Cat Sx, female, hyperopia, caucasion

75
Q

Dry AMD symptoms:

A

Bilateral asymmetrical gradual loss of central vision
Metamorphopsia (Drusen > PR displacement)
Central scotoma (geographic atrophy)

75
Q

Exudative AMD symptoms:

A

Painless blurring central vision (in days)
Metamorphopsia/scotoma
Sudden vision loss (vit. Haem.)

76
Q

Exudative AMD clinical presentation/signs:

A

CNV: yellow central dome elevation w/PED
Haemorrhagic PED: dark sub-RPE dome > vit-haem
Fibrovascular disciform scar: healed CNV > white patch (permeant blur)

77
Q

PC AMD:

A

Difficulty reading/knitting
Poor facial recognition
Central scotoma (black/grey)
Lines wavey
Poor dark/light adaptation
Asymptomatic

78
Q

DDX gradual loss of central vision:

A

Dry AMD
Macula oedema
Macula hole
ERM
Adult best vitelliform dystrophy

78
Q

DDX sudden painless loss of vision:

A

Wet AMD
CSCR
RRD
CR/BR VO
CR/BR AO
N/A AION
Chorioretinitis (toxoplasmosis)

78
Q

RP symptoms:

A

Nyctalopia: initial Rod loss
Peripheral loss: Tunnel vision from Rod loss
Photophobia: Rod/Cone loss > doubled recovery time for photopic stress
Photopsia: altered PR signals > peripheral shimmering
Central vision loss: Late cone loss

78
Q

RP signs:

A

Bony spicules: interstitial pigment clumps
ON pallor: white/waxy from Gliosis/ganglion death
BV attenuation: PR loss > attenuation / CC atrophy
Macula oedema: BRB loss > leakage
ERM: Atrophy/BRB loss > proliferative vitreoretinopathy
Bulls eye maculopathy / PSC / Vit. Degen.

79
Q

CNSB symptoms:

A

Nyctalopia w/poor light-dark adaptation
Photophobia, strabismus, nystagmus
Varied fundus: pigmented, scattered dots
ERG shows low red response, normal cone
Associated myopia

79
Q

BEST vitelliform macula dystrophy signs:

A

Abnormal EOG > macula drusenoid lesion > pseudohypopyon > ruptured lesion > macula atrophy
VA decreases past 6/60

79
Q

Stargardt disease and FFM signs:

A

Present 10-20yo w/ central vision loss (macula)
Mottled/metal macula > bulls eye maculopathy/atrophy
Pisciform (fish shape) flecks on fundus
VA stabilises at 6/60

OPTO3003 (18 decks)

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